Category: Statistics

Thromb Res. 2025 Sep 5;254:109452. doi: 10.1016/j.thromres.2025.109452. Online ahead of print.

ABSTRACT

Warfarin is a widely used vitamin K antagonist (VKA) with known pleiotropic effects beyond anticoagulation. Preclinical and case-control evidence suggests that warfarin may affect hematopoiesis, but longitudinal human evidence is lacking. To explore this potential effect, we conducted a post-hoc analysis of participants in the Hokusai-VTE and ENGAGE AF-TIMI 48 trials, which randomized patients to warfarin or the direct oral anticoagulant edoxaban with routine laboratory testing at predefined follow-up visits. We analyzed changes in total circulating white blood cells (WBC) and subpopulations (lymphocytes, monocytes, granulocytes) using linear regression and mixed-effects models, adjusting for baseline counts, age, sex, and time. Among 23,618 patients enrolled in the two phase 3 trials, warfarin use was associated with a modest but statistically significant reduction in WBC count (-2.3 %, 95 % CI -2.9 % to -1.7 %) and granulocyte count (-3.6 %, 95 % CI -4.5 % to -2.7 %) compared with edoxaban, while lymphocyte and monocyte counts did not differ. The associations remained consistent across multiple sensitivity analyses. No increase in clinically relevant granulocytopenia was observed. In the context of two large randomized trials, these findings support a subtle hematologic effect of warfarin, particularly in granulocytes, that aligns with preclinical findings and warrants further investigation into the long-term impact of VKAs on hematopoiesis.

PMID:40925065 | DOI:10.1016/j.thromres.2025.109452

Thromb Res. 2025 Sep 5;254:109452. doi: 10.1016/j.thromres.2025.109452. Online ahead of print.

ABSTRACT

Warfarin is a widely used vitamin K antagonist (VKA) with known pleiotropic effects beyond anticoagulation. Preclinical and case-control evidence suggests that warfarin may affect hematopoiesis, but longitudinal human evidence is lacking. To explore this potential effect, we conducted a post-hoc analysis of participants in the Hokusai-VTE and ENGAGE AF-TIMI 48 trials, which randomized patients to warfarin or the direct oral anticoagulant edoxaban with routine laboratory testing at predefined follow-up visits. We analyzed changes in total circulating white blood cells (WBC) and subpopulations (lymphocytes, monocytes, granulocytes) using linear regression and mixed-effects models, adjusting for baseline counts, age, sex, and time. Among 23,618 patients enrolled in the two phase 3 trials, warfarin use was associated with a modest but statistically significant reduction in WBC count (-2.3 %, 95 % CI -2.9 % to -1.7 %) and granulocyte count (-3.6 %, 95 % CI -4.5 % to -2.7 %) compared with edoxaban, while lymphocyte and monocyte counts did not differ. The associations remained consistent across multiple sensitivity analyses. No increase in clinically relevant granulocytopenia was observed. In the context of two large randomized trials, these findings support a subtle hematologic effect of warfarin, particularly in granulocytes, that aligns with preclinical findings and warrants further investigation into the long-term impact of VKAs on hematopoiesis.

PMID:40925065 | DOI:10.1016/j.thromres.2025.109452

Int J Orthop Trauma Nurs. 2025 Aug 29;59:101221. doi: 10.1016/j.ijotn.2025.101221. Online ahead of print.

ABSTRACT

BACKGROUND: Knee osteoarthritis (KOA) is a prevalent degenerative joint disorder that significantly impairs physical function and daily activities. While conventional treatments focus on symptom management, complementary therapies such as aromatherapy massage have gained attention for their potential benefits.

OBJECTIVE: This study evaluates the effects of peppermint oil aromatherapy massage on functional impairments in KOA patients.

METHODS: A randomized controlled trial was conducted on 120 KOA patients at Shahid Beheshti Hospital, Kashan, Iran at October 2024 to December 2024. Participants were randomly assigned to three groups: intervention (peppermint oil massage), placebo (paraffin oil massage), and control (no intervention). The intervention and placebo groups received biweekly 15-min knee massages for four weeks. Functional outcomes were assessed using the Knee Injury and Osteoarthritis Outcome Score (KOOS) at baseline, post-intervention, and one-month follow-up. Statistical analyses included chi-square, ANOVA, and repeated measures ANOVA.

RESULTS: Baseline characteristics and KOOS subscale scores were comparable across groups (p > 0.05). The intervention group demonstrated significant improvements in pain reduction, symptom relief, and daily function over time (p < 0.001), while no significant changes were observed in the sports and recreation subscale (p > 0.05). ANOVA confirmed significant intergroup differences in KOOS subscales of pain, symptoms, and daily function at all time points (p < 0.05), except for sports/recreation and quality of life (p > 0.05).

CONCLUSION: Peppermint oil aromatherapy massage significantly alleviates KOA-related pain and functional impairment, enhancing daily activities and overall well-being. Given its non-invasive nature and ease of application, this intervention could be recommended as an adjunctive therapy for KOA management.

PMID:40925064 | DOI:10.1016/j.ijotn.2025.101221

Int J Orthop Trauma Nurs. 2025 Aug 29;59:101221. doi: 10.1016/j.ijotn.2025.101221. Online ahead of print.

ABSTRACT

BACKGROUND: Knee osteoarthritis (KOA) is a prevalent degenerative joint disorder that significantly impairs physical function and daily activities. While conventional treatments focus on symptom management, complementary therapies such as aromatherapy massage have gained attention for their potential benefits.

OBJECTIVE: This study evaluates the effects of peppermint oil aromatherapy massage on functional impairments in KOA patients.

METHODS: A randomized controlled trial was conducted on 120 KOA patients at Shahid Beheshti Hospital, Kashan, Iran at October 2024 to December 2024. Participants were randomly assigned to three groups: intervention (peppermint oil massage), placebo (paraffin oil massage), and control (no intervention). The intervention and placebo groups received biweekly 15-min knee massages for four weeks. Functional outcomes were assessed using the Knee Injury and Osteoarthritis Outcome Score (KOOS) at baseline, post-intervention, and one-month follow-up. Statistical analyses included chi-square, ANOVA, and repeated measures ANOVA.

RESULTS: Baseline characteristics and KOOS subscale scores were comparable across groups (p > 0.05). The intervention group demonstrated significant improvements in pain reduction, symptom relief, and daily function over time (p < 0.001), while no significant changes were observed in the sports and recreation subscale (p > 0.05). ANOVA confirmed significant intergroup differences in KOOS subscales of pain, symptoms, and daily function at all time points (p < 0.05), except for sports/recreation and quality of life (p > 0.05).

CONCLUSION: Peppermint oil aromatherapy massage significantly alleviates KOA-related pain and functional impairment, enhancing daily activities and overall well-being. Given its non-invasive nature and ease of application, this intervention could be recommended as an adjunctive therapy for KOA management.

PMID:40925064 | DOI:10.1016/j.ijotn.2025.101221

J Econ Entomol. 2025 Sep 9:toaf204. doi: 10.1093/jee/toaf204. Online ahead of print.

ABSTRACT

The Citrus Under Protective Screen is a novel production system implemented to grow citrus free of huanglongbing disease vectored by Asian citrus psyllid, Diaphorina citri. Other significant pests such as mites, scales, thrips, mealybugs, and leafminers, as well as parasitoids and small predators, have been identified from Citrus Under Protective Screen and require management. Chrysomphalus aonidum (L.), an armored scale is a major pest of citrus. We determined the incidence of C. aonidum and parasitoid Aphytis melinus in 4-quarter-acre Citrus Under Protective Screen structures and open-air controls planted with grapefruit (Citrus paradisi). The greatest difference between the 2 production systems in temperature and humidity was observed using daily maximum values. Except for 2 of the 26 mo of study, the maximum daily temperature was significantly higher in the Citrus Under Protective Screen than in open-air, ranging from -0.6 to 16.1 °C. The maximum relative humidity between the 2 systems averaged 91% to 99%. C. aonidum was exclusively found in the in-ground trees in the Citrus Under Protective Screen, infesting 11% to 12% of trees from 2020 to 2022. The density of C. aonidum increased from 2020-2021 to 2021-2022 sampling cycle, averaging 7.81/cm2 and 15.55/cm2 on the leaves, respectively, and 3.09/cm2 and 5.63/cm2 on fruit, respectively. A. melinus captures on the yellow sticky cards were significantly higher in the Citrus Under Protective Screen than in open-air. Significantly higher numbers of C. aonidum were parasitized on leaves than on fruit, averaging 19% to 23% and 0.78% to 1.53%, respectively. Findings suggest the risk of C. aonidum infestation and prospects for biological control in Citrus Under Protective Screen.

PMID:40925045 | DOI:10.1093/jee/toaf204

J Econ Entomol. 2025 Sep 9:toaf204. doi: 10.1093/jee/toaf204. Online ahead of print.

ABSTRACT

The Citrus Under Protective Screen is a novel production system implemented to grow citrus free of huanglongbing disease vectored by Asian citrus psyllid, Diaphorina citri. Other significant pests such as mites, scales, thrips, mealybugs, and leafminers, as well as parasitoids and small predators, have been identified from Citrus Under Protective Screen and require management. Chrysomphalus aonidum (L.), an armored scale is a major pest of citrus. We determined the incidence of C. aonidum and parasitoid Aphytis melinus in 4-quarter-acre Citrus Under Protective Screen structures and open-air controls planted with grapefruit (Citrus paradisi). The greatest difference between the 2 production systems in temperature and humidity was observed using daily maximum values. Except for 2 of the 26 mo of study, the maximum daily temperature was significantly higher in the Citrus Under Protective Screen than in open-air, ranging from -0.6 to 16.1 °C. The maximum relative humidity between the 2 systems averaged 91% to 99%. C. aonidum was exclusively found in the in-ground trees in the Citrus Under Protective Screen, infesting 11% to 12% of trees from 2020 to 2022. The density of C. aonidum increased from 2020-2021 to 2021-2022 sampling cycle, averaging 7.81/cm2 and 15.55/cm2 on the leaves, respectively, and 3.09/cm2 and 5.63/cm2 on fruit, respectively. A. melinus captures on the yellow sticky cards were significantly higher in the Citrus Under Protective Screen than in open-air. Significantly higher numbers of C. aonidum were parasitized on leaves than on fruit, averaging 19% to 23% and 0.78% to 1.53%, respectively. Findings suggest the risk of C. aonidum infestation and prospects for biological control in Citrus Under Protective Screen.

PMID:40925045 | DOI:10.1093/jee/toaf204

Turk J Pediatr. 2025 Sep 1;67(4):473-482. doi: 10.24953/turkjpediatr.2025.5850.

ABSTRACT

BACKGROUND: With the development of technology, easier access to the internet and its excessive use have led to problematic internet use (PIU). The prevalence of PIU and its association with lifestyle behaviors in adolescents have become subjects of increasing academic interest. This study aimed to determine the prevalence of PIU among Turkish high school students and to investigate its association with sleep, physical activity and dietary habits.

METHODS: This cross-sectional study was conducted on high school students between October 2019 and March 2020. Participants completed a questionnaire regarding demographic characteristics, internet use, lifestyle habits and the “Young Internet Addiction Test-Short Form (YIAT-SF)”.

RESULTS: Among the total 951 participants, the mean age was 15.3±1.0 years, 42.3% were female, and the prevalence of PIU was determined as 12.1%. It was shown that having daily internet usage time ≥2 hours on weekdays, having at least one type of sleep problem, having breakfast less than 3 days per week, eating salty snacks ≥3 days per week, consuming sugary-carbonated drinks ≥3 days per week were associated with PIU.

CONCLUSIONS: PIU is a widespread public health problem that is negatively associated with the daily health habits of adolescents. There is a need for nationwide school screening programs for this problem and rehabilitation of adolescents diagnosed with PIU.

PMID:40925033 | DOI:10.24953/turkjpediatr.2025.5850

Turk J Pediatr. 2025 Sep 1;67(4):559-568. doi: 10.24953/turkjpediatr.2025.6171.

ABSTRACT

BACKROUND: Leukemia is the most common childhood malignancy and often presents with nonspecific symptoms, which may lead to delays in diagnosis. Early recognition of clinical signs and laboratory abnormalities is essential to ensure timely referral and improve outcomes. This study assesses the clinical and laboratory characteristics of pediatric patients with acute and relapsed leukemia, points out key considerations during diagnosis, and investigates potential factors contributing to delayed diagnosis.

METHODS: A retrospective analysis was performed on pediatric patients diagnosed with leukemia at a tertiary care hospital between the years 1986 and 2020. Early diagnosis was defined as a diagnosis made within 20 days of symptom onset.

RESULTS: Among the 378 patients, fatigue was the most frequently reported symptom, followed by fever and bone or joint pain. Common laboratory abnormalities included anemia (83%), thrombocytopenia (80%), and leukocytosis (46%). Bone or joint pain (p< 0.001), mucosal bleeding (p=0.013), and pallor (p=0.005) were significantly associated with late diagnosis. In contrast, lymphadenopathy (p=0.014) and bone tenderness (p=0.024) were linked to earlier recognition. Among laboratory findings, low hemoglobin levels were associated with early diagnosis (p=0.023) and elevated platelet count was also significantly related to delayed diagnosis (p=0.028). In relapsed leukemia cases, abnormal blood count findings were common, and neurological symptoms were observed more frequently compared to acute leukemia patients.

CONCLUSIONS: Fatigue, fever, and bone or joint pain were identified as the most common presenting symptoms in acute leukemia cases, while hepatomegaly, splenomegaly, and lymphadenopathy were the predominant physical findings. Bone or joint pain, mucosal bleeding, and pallor were associated with late diagnosis, whereas lymphadenopathy and bone tenderness appeared to facilitate earlier recognition.

PMID:40925026 | DOI:10.24953/turkjpediatr.2025.6171

JMIR Res Protoc. 2025 Sep 9;14:e69716. doi: 10.2196/69716.

ABSTRACT

BACKGROUND: In-hospital cardiac arrest (IHCA) remains a public health conundrum with high morbidity and mortality rates. While early identification of high-risk patients could enable preventive interventions and improve survival, evidence on the effectiveness of current prediction methods remains inconclusive. Limited research exists on patients’ prearrest pathophysiological status and predictive and prognostic factors of IHCA, highlighting the need for a comprehensive synthesis of predictive methodologies.

OBJECTIVE: This scoping review aims to synthesize and critically evaluate the quality and quantity of clinical features and machine learning (ML) models for predicting IHCA. The review will evaluate temporal characteristics, predictive and prognostic values of prearrest clinical features, and model performance metrics.

METHODS: This scoping review follows the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines and aims to synthesize studies that used ML algorithms to predict IHCA published between April 2009 and April 2024. We will conduct a comprehensive search using 4 major databases: PubMed, Web of Science, IEEE Xplore, and Embase. The inclusion criteria are peer-reviewed, English-language studies that explore ML applications for predicting IHCA in adult patients (aged ≥18 years). Exclusion criteria include review articles, preprints, non-English-language studies, and studies without specific ML metrics for IHCA prediction. Two independent reviewers will conduct the screening and data extraction using Rayyan for deduplication and ensuring study eligibility. Descriptive statistics will be used to summarize the data, and a narrative synthesis will provide insights into the clinical features used in the models, the performance metrics, and any gaps in the literature.

RESULTS: A total of 2479 records were identified between April 2009-April 2024. After removing duplicates and conducting screening, 16 studies have been included in the review. Data extraction and synthesis are ongoing and are expected to be completed by June 2025. The anticipated results from this review will provide a comprehensive overview of the clinical predictors of IHCA used in ML models, including commonly reported clinical features such as vital signs, biomarkers, and comorbidities. We expect to highlight variations in data quality and quantity across studies, which may influence model performance.

CONCLUSIONS: This study will contribute to advancing ML applications for IHCA prediction by addressing data challenges and promoting standardization to improve the clinical decision-making process. The results of this review are expected to inform future studies; promote consistency in the reporting of clinical features; and, ultimately, enhance the decision-making process in clinical settings, potentially leading to better outcomes for patients experiencing IHCA.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/69716.

PMID:40925002 | DOI:10.2196/69716

J Med Internet Res. 2025 Sep 9;27:e78810. doi: 10.2196/78810.

ABSTRACT

BACKGROUND: Mobile health (mHealth) interventions can be effective for people living with HIV, who are sensitive to privacy breach risks. Understanding the perceived experiences of intervention participants can provide comprehensive insights into potential users and predict intervention effectiveness. Thus, it is necessary to plan engagement measurement and consider ways to enhance engagement during the app development phase.

OBJECTIVE: This study aims to evaluate engagement with a mHealth app using the engagement index and time and to examine differences in engagement according to participant characteristics.

METHODS: This observational study, conducted from March 27 to August 31, 2024, was based on an engagement evaluation framework. A total of 261 people living with HIV across 13 medical institutions and 3 related organizations in South Korea engaged in an app-based intervention for 4 weeks. Self-reported surveys were conducted before and after the app usage period, and usage data were collected during the intervention to assess user engagement. User engagement was evaluated using 2 measures: engagement index and engagement time. The engagement index represents a standardized percentage derived from 5 subindices: click depth, loyalty, recency, feedback, and interaction.

RESULTS: The median engagement index and time were 67.6% (IQR 59.7-74.1) and 27.2 minutes (IQR 4.9-81.4), respectively, with a statistically significant positive correlation between the two (ρ=0.589; P<.001). The engagement index was higher among those with self-help group participation (U=6014.0, z=-2.49; P=.01). There were no differences in engagement index and time according to other personal characteristics.

CONCLUSIONS: When developing mHealth apps for people living with HIV, it is essential to track both objective indicators such as login data and subjective indicators such as patient experience for comprehensive intervention evaluation. Based on this study’s results, high engagement suggests that apps should prioritize user needs through rewards, privacy protection, tailored information, and esthetic features. While the app in this study demonstrated inclusive usability, targeted support strategies may benefit users without self-help group participation.

PMID:40925000 | DOI:10.2196/78810